In Florida today, Mitt Romney began to sketch out in general terms the healthcare plan with which he would replace Obamacare.
With respect to the uninsured, he’ll let the states have a go at the problem:
Some [states] send uninsured people to clinics for care, others send them to emergency rooms. What I would do is keep, as we have today, state responsibility for those that are uninsured. You see, I believe in the Tenth Amendment. I believe that the states have responsibility to care for their people in the way they feel best. But to help states care for their own uninsured, I would take the Medicaid dollars that come with all sorts of strings attached today, send them back to the states along with something known as the dish money, and let states care for their own people in the way they think best.
As Rep. Paul Ryan (R-Wis.) and a number of conservative think tanks have argued, Romney said it is important to “get healthcare to act more like a consumer market.” He added: “Consumer markets tend to work very well: keep the costs down and the quality up.” He would also “level the playing field and say individuals can buy insurance on the same tax advantage basis that businesses can buy insurance.” This too is an item on most conservative reformers’ to-do list.
With a bow toward the politics on pre-existing conditions, he said, “I don’t want [people] to be denied insurance because they’ve got some preexisting condition so we’re going to have to make sure that the law we replace Obamacare with assures that people who have a preexisting condition, who’ve been insured in the past are able to get insurance in the future so they don’t have to worry about that condition keeping them from getting the kind of health care they deserve.” Luckily, several major healthcare insurers have said the would do this voluntarily.
Other measures to help foster consumer markets include allowing “individuals and businesses to be able to buy insurance across state lines, to get the best deal they can get anywhere in the country” and letting businesses join “associations of like types of organizations so they can get bargaining power, purchasing power and get insurance at a reasonable rate.”
Finally, he made the case that his Medicare reform plan will address a major driver of healthcare costs, the current Medicare system. The proposal (which mirrors the Ryan-Wyden plan) would give seniors a choice of “traditional, government sponsored Medicare or private sector Medicare, provided by various companies, and let them make their choices as to which one they want.” He made clear that higher income people “should get less help getting Medicare than lower income people.”
Needless to say, this is the outline of a plan, not a complete healthcare bill. There will be lots of blanks to fill in. How much is the Medicare premium subsidy, and when does it phase out for richer Americans? What if states won't cover the uninsured? How much in cost savings can be wrung out of the market with this approach? That said, it is an approach very much in keeping with conservative reform plans that have floated around for some time. Whether the Supreme Court invalidates Obamacare or not, Romney will need to put some meat on the bones he presented today.